[Better individual adaptation in future maternal health care. Routine check-ups are based on weak scientific grounds].
Explore the source record for details and available documents.
Female↗
Biomedical subjects
G Lindmark
Publications and source records attributed to G Lindmark.
Heterogeneity in ploidy and S-phase fraction in colorectal adenocarcinomas.
The heterogeneity in the DNA content was analysed in multiple biopsies from the surgical specimens in 77 cases of colonic and 46 cases of rectal adenocarcinomas. Frozen and unfixed tumour tissue was analysed with the flow cytometric technique. A total of 78/123 (63%) of all tumours displayed aneuploid stemlines in one or more pieces of tumour tissue; 45 were homogeneously aneuploid and 33 were heterogeneous, presenting both aneuploid and near-diploid samples. The remaining 45 tumours were homogeneously near-diploid. The heterogeneity in ploidy tended to be slightly higher if ten as compared with four samples from each tumour were analysed. Ploidy correlated to localization in the bowel and gender, but not to age, histopathological tumour stage, tumour differentiation or to the resectability rate for cure. The mean value of the S-phase fraction was 17% (range 7-31%) in the near-diploid and 14% (range 8-20%) in the aneuploid tumours. The range of the intratumoural variation was small for the DNA index (at most 5%) and high for the S-phase fraction (19% for near-diploid and 24% for aneuploid tumour pieces). Neither the mean value nor the heterogeneity in the DNA index and in the S-phase fraction displayed any correlation with the studied characteristics. In conclusion, the ploidy and the S-phase fraction varied considerably both within and between the tumours. As a consequence, multiple sampling is mandatory for a correct classification of colorectal adenocarcinomas based on the DNA content.
Adenocarcinoma↗
A hospital study of the complications of female circumcision.
During one year 118 patients were admitted to the operative gynecological ward of Banadir Maternity Hospital, Mogadishu, Somalia, with diseases related to the practice of female circumcision. Fifty-five per cent of the patients were suffering from a dermoid cyst at the site of the excised clitoris. Thirty-six per cent had a vaginal stenosis and 9% an abscess at the site of the excised clitoris. These patients occupied the beds of the hospital for a total period of 1967 days which posed a significant constraint to the health services of the hospital.
Adolescent↗
The scientific basis of antenatal care. Report from a state-of-the-art conference.
The routine program for antenatal care consists of a number of scheduled visits aiming at detection of symptomless complications such as hypertension and deviation in fetal growth, as well as giving psychosocial support and health education. In a Swedish state-of-the-art conference in May 1990, the scientific basis of this routine program was critically evaluated. It was clearly demonstrated that the scientific evidence to support present timing and contents of routine visits is unsatisfactory, and that there is a great need for evaluation both of single diagnostic procedures and intervention and of programs of antenatal care. Evaluations of antenatal care should consider not only pregnancy outcome but also patient satisfaction and cost-benefit analysis. Long-term follow-up studies are urgently needed, not only of the effects of complications but also of antenatal diagnosis and interventions.
Evaluation Studies as Topic↗
Female circumcision in Somalia and women's motives.
Two hundred and ninety Somalian women have participated in a study. They responded adequately to the questionnaire administered. One hundred percent of these women were circumcised, despite their relatively high socio-economic status as shown by their educational level. Eighty-eight percent of them had been circumcised with excision and infibulation, 6.5% were circumcised with clitoridectomy and the remaining 5.5% with Sunna. The majority of these women justified the practice of female circumcision with religious reasons and all were willing to circumcise their daughters. Fifty-two percent of the respondents had been operated on by medically untrained persons, usually traditional birth attendants and the majority were operated on at home.
Adolescent↗
Gestational diabetes-perinatal outcome with a policy of liberal and intensive insulin therapy.
During 3 years of continuous screening for gestational diabetes mellitus in the county of Uppsala, 133 pregnant women (1.2%) were given this diagnosis. Maternal characteristics and the perinatal outcome of the pregnancies were examined retrospectively. Maternal overweight [body mass index greater than 23.9 kg/(m)2] was noted in 54.9% of the 133 women. Insulin therapy, with a mean daily dose of 42 U, was given to 62.4% of the patients, whereas the others were given dietary instructions alone. The frequency of infants with a birth weight greater than 2 SD was 24.1% and was significantly (p less than 0.025) related to pre-pregnancy overweight and also to pregnancy weight gain 18kg (p less than 0.01). Caesarean section was performed in 27% of the pregnancies complicated by diabetes, compared with the overall figure of 11% in Uppsala during the study period. Neonatal hypoglycaemia (blood glucose greater than or equal to 1.6 mM) was noted in 17.3% of the infants and was significantly (p less than 0.01) related to maternal sympathomimetic therapy. Despite liberal and intensive insulin therapy, there was a considerable rate of perinatal complications. Although not severe, they indicate a need for further improvement in the care of women with gestational diabetes.
Diabetes, Gestational↗
[Extremely low birth weight infants. Who is to receive intensive care?].
Explore the source record for details and available documents.
Humans↗
A study of antenatal care at village level in rural Tanzania.
Antenatal care is an acknowledged measure for the reduction of maternal and perinatal mortality. In the rural village of Ilula, Tanzania, the possible impact of antenatal care on mortality was studied longitudinally on the basis of the 707 women delivered in the study period. Ninety-five percent of the antenatal records were available. Anemia, malaria and anticipated obstetric problems were the most frequent reasons for interventions. Among the women from the area who were delivered in hospital, 90% had been referred there. No relationship was found between the number of antenatal visits and the pregnancy outcome, but perinatal mortality was correlated to a low birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and perinatal mortality remains high.
Female↗
Maternal weight, weight gain and birthweight at term in the rural Tanzanian village of Ilula.
In an area-based study in a rural Tanzanian village, the relations of maternal weight and weight gain during pregnancy to birthweight were analysed for 331 term deliveries. The distribution of body-mass index, used as an indicator of maternal nutritional status, was similar to the pattern seen in Sweden, although mean maternal height (156 cm) was 9 cm below that of Swedish women. Mean initial weight measured at week 14 was 53 kg and total pregnancy weight gain was 6 kg. Women weighing greater than or equal to 60 kg in early pregnancy gained less weight (0.16 kg/week) than those weighing less than 50 kg (0.22 kg/week). Birthweight was correlated both with maternal weight in early pregnancy and with weight gain during pregnancy, but only 10% of the variation in birthweight was explained by these maternal factors. Mean maternal weight 24 h postpartum was equal to the weight at 14 weeks of pregnancy, implying, on the average, no net weight gain. Women with a positive net weight gain had heavier babies than women with a negative net weight gain. Maternal anthropometric characteristics are important underlying determinants of intrauterine growth and birthweight, but they explain only a minor part of the variation and are of little value for screening purposes in individual women.
Adult↗
Placental hormones and maternal glucose metabolism. A study of fetal growth in normal pregnancy.
The interrelations between three placental hormones (oestradiol, progesterone and hPL), maternal glucose metabolism, maternal anthropometry and fetal growth were studied in a sample of 52 carefully selected pregnant women. A relation was found between infant birthweight and both fasting blood glucose and t1/2 of glucose of an intravenous glucose tolerance test at week 37 of pregnancy. The serum concentrations of the placental hormones were not significantly related to the glucose variables. The correlation between birthweight and the maternal levels of hPL in late pregnancy (r = 0.60) persisted when fasting blood glucose and t1/2 of glucose were taken into account. Maternal fat mass was found to explain more of the variation in basal insulin levels around week 37 than did the placental hormones.
Adipose Tissue↗
Preliminary results from the Collaborative Alabama and Scandinavian Study of Successive Small-for-Gestational Age Births.
The study "Successive Small-for-Gestational Age Births" (SGA study) was initiated and is sponsored by the National Institutes of Health (N.I.H.) in the U.S.A. Its purpose is to describe and characterize the different types of intra-uterine growth retardation and their consequences, to assess the associated risk factors, and to provide a basis for preventive measures. Starting in 1986, it runs concurrently in Bergen and Trondheim (Norway), Uppsala (Sweden) and Birmingham, Alabama (U.S.A.), recruiting pregnant para 1 and 2 mothers at high risk of having an SGA birth and a random (control) sample of the total pregnant population. Data collection will end in late 1989, when the last-born children have reached 13 months of age. At the present symposium, investigators from all four study centers and the N.I.H. described the study design and discussed problems of methodology. Strict standardization of parameters to determine gestational age (ultrasound, menstrual dates) is a prerequisite for comparison of results over time and between study centers. Some preliminary results were presented.
Alabama↗
A prospective area-based study of the outcome of pregnancy in rural Tanzania.
A prospective area-based study on the outcome of pregnancy was carried out in the rural village of Ilula in Tanzania. A coverage of 99% (n = 719) regarding the ultimate outcome for mother and child was achieved, including deliveries that took place in hospital (9%), at the dispensary (67%) and at home (23%). There were four maternal deaths (6/1,000). The mean birth weight for singletons was 3,070 g and the low birth weight (less than 2,500 g) rate 13%. From a gestational age of 37 weeks onwards there was a definite slowing of fetal growth. Perinatal mortality rate was 82 per 1,000 born, half of the deaths occurring in low birth weight babies. Twinning occurred in 3.5% and the mean length of gestation at delivery for these pregnancies was 35.5 weeks. Twins constituted 6.8% of newborns but accounted for 23.0% of perinatal losses, making twin pregnancy a major contributor to perinatal mortality. Post-term pregnancies carried no significant increase in mortality. It is concluded that reliable area-based data on the outcome of pregnancy in Tanzania can be obtained at village level, with good coverage of the study population, by properly instructed and motivated local staff with moderate supervisory support.
Delivery, Obstetric↗
Maternal glucose metabolism and infant birth weight: a study in healthy pregnant women.
An intravenous glucose tolerance test (IVGTT) with serum insulin determinations was performed at week 37 of pregnancy in 52 healthy primiparae, selected to provide an increased variation in infant birth weight. A significant relationship was found between infant birth weight and both fasting blood glucose and t1/2 of glucose. Infant skinfold thickness, however, was not correlated independently to any of the parameters of the IVGTT. There was a significant correlation between maternal lean body mass and glucose metabolism, but this could not fully explain the relation between lean body mass and infant birth weight. Maternal fat mass was not significantly correlated to infant birth weight, though it was correlated with serum insulin levels. In the investigated population, fasting blood glucose, t1/2 of glucose, and maternal lean body mass accounted for 27% of the variation in infant birth weight.
Adult↗
Relative effect of parental birth weight on infant birth weight at term.
The relations between some hereditary and environmental factors and the variation in infant birth weight were estimated by multiple linear regression analyses on a sample of 276 Scandinavian single term pregnancies. Gestational age explained 10.9%, fetal factors (maternal and paternal birth weights and fetal sex) 7.9%, maternal factors (parity, pre-pregnancy weight and height) 5.5% and external factors (adjusted weight gain and smoking) 5.8% of the variation in infant birth weight. It is concluded that maternal and paternal birth weights are rather poor predictors of infant birth weight. Together they explain only 5.6% of the variation in infant birth weight at term.
Analysis of Variance↗
Maternal fat stores and fat accretion during pregnancy in relation to infant birthweight.
Maternal fat stores and fat accretion during pregnancy were estimated from body weight and skinfold thicknesses and by the factorial method in a sample of 56 Swedish women in their second pregnancies who gave birth to singletons at term. Prepregnancy lean body mass, and not fat mass, were strongly correlated with infant birthweight. Total weight gain was significantly correlated with infant birthweight. A wide range of maternal fat accretion during pregnancy was observed, and the amount of fat accumulated was related to the total weight gain. In spite of this, maternal fat accretion during pregnancy was found to have little bearing on the infant birthweight at term.
Adult↗
Energy intake and physical activity during pregnancy in relation to maternal fat accretion and infant birthweight.
During the second pregnancy of 56 Swedish women resulting in a term birth, energy intake and physical activity were measured for 3 days at weeks 17 and 33. The values were related to maternal lean body mass, pregnancy weight gain, maternal fat accretion and infant birthweight by multiple linear regression analyses. A significant regression coefficient was found for energy intake at week 17 on maternal fat accretion. Energy intake was not significantly correlated with infant birthweight, not even when physical activity and maternal lean body mass were taken into account. Thus in a well-nourished Swedish population, energy intake is positively related to maternal fat accretion but not to the birthweight of term infants.
Birth Weight↗
Methodological problems of clinical trials in nursing illustrated by a study of post-partum care.
Explore the source record for details and available documents.
Adult↗
Early and late discharge after hospital birth: breastfeeding.
Breastfeeding was studied among women discharged early and late after normal delivery in a hospital. Early discharge was defined as leaving the hospital 24-48 h after delivery in combination with domiciliary visits, and late discharge as the regular hospital postpartum care (mean 6 days). 164 women interested in participating in the early discharge study were randomly allocated in late pregnancy to a group offered early discharge (Experimental group = EG) or a group offered the traditional later discharge (Control group = CG). After medical exclusions and non-medical withdrawals, 50 mother-infant couples remained in EG and 54 in CG. Regular breastfeeding at 6 months after birth was reported by 63% of the multiparae in EG and 41% in CG (p = 0.06). Thirty-three per cent of the primiparae in each group were still breastfeeding at 6 months. 2% of the infants in EG and 72% in CG received supplementary breastmilk at least once during their first week of life. Infants discharged early were breastfed more often on the 2nd (NS), 3rd (p less than 0.05) and 4th day (p less than 0.001) after birth, compared with infants who stayed longer in hospital. There were no statistically significant differences between EG and CG women in their experience of success in breastfeeding according to daily records from the first 14 days after the birth.
Breast Feeding↗